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Evidencias en Pediatría (EP / Evidences in Pediatrics) is a publication of the “Asociación Española de Pediatría” (AEP / Spanish Association of Pediatrics). Its contents are elaborated mainly by members of the Grupo de Trabajo de Pediatría Basada en la Evidencia (Evidence Based Pediatrics Working Group). This group is part of both, the AEP and the “Asociación Española de Pediatría de Atención Primaria” (Spanish Association of Primary Care Pediatrics / AEPap).
Authors’ conclusion: ultrasound strategies aimed at the diagnosis of the developmental dysplasia of the hip, have not demonstrated to improve the results, including late diagnosis of developmental dysplasia of the hip and surgery. However, the included studies are substantially underpowered to detect significant differences in these uncommon events.
Reviewers’ commentary: due to the low incidence of developmental dysplasia of the hip and its consequences (surgery, avascular necrosis of the femoral head, osteoarthritis...), currently there are no studies with sufficient sample size and methodological quality to answer the question. Recent studies, of low methodological quality, report benefit of universal screening to reduce the need for surgery, but do not rule out the possibility that this intervention will increase the need for treatments that in many cases are unnecessary (mild dysplasia resolves spontaneously between 6 weeks and 6 months in >90% of untreated hips) and are not without complications.
Patel H; Canadian Task Force on Preventive Health C. Preventive health care, 2001 update: screening and management of developmental dysplasia of the hip in newborns. CMAJ. 2001;164:1669-77.
Von Kries R, Ihme N, Altenhofen L, Niethard FU, Krauspe R, Rückinger S. General ultrasound screening reduces the rate of first operative procedures for developmental dysplasia of the hip: a case-control study. J Pediatr. 2012;160:271-5.
Thaler M, Biedermann R, Lair J, Krismer M, Landauer F. Cost-effectiveness of universal ultrasound screening compared with clinical examination alone in the diagnosis and treatment of neonatal hip dysplasia in Austria. J Bone Joint Surg Br. 2011;93:1126-30.
Woolacott NF, Puhan MA, Steurer J, Kleijnen J. Ultrasonography in screening for developmental dysplasia of the hip in newborns: systematic review. BMJ. 2005;330:1413-8.
Roposch A, Moreau NM, Uleryk E, Doria AS. Developmental dysplasia of the hip: quality of reporting of diagnostic accuracy for US. Radiology. 2006;241:854-60.
Perdikis Olivieri L, González de Dios J. El cribado ecográfico de displasia de desarrollo de caderas sólo se justifica en recién nacidos con determinados factores de riesgo. Evid Pediatr. 2005;1:4.
Elbourne D, Dezateux C, Arthur R, Clarke NM, Gray A, et al. Ultrasonography in the diagnosis and management of developmental hip dysplasia (UK Hip Trial): clinical and economic results of a multicentre randomised controlled trial. Lancet. 2002;360(9350):2009-17.